Provider Update Newsletter

Provider Update Newsletter Medicaid, Medicare, Marketplace

This is the workhorse in our communications stable of materials. We launched our first edition in October 2020. It is delivered to all providers electronically each month. This communication vehicle covers essential operational and procedural topics to help you do business with Buckeye. It will also deliver training and education opportunities and include some of Buckeye's provider-based initiatives. All editions of the newsletter will be available on the website.

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Welcome to the November 2023 Provider Update Newsletter

November 30, 2023



Medicare Step Therapy Part B Drug List Changes - 2024

The 2024 Medicare Step Therapy programs and drug list for 2024 are available for your review. Please see all the details and list of drug changes.

Important Pharmacy Claims Processing Change Eff. January 1, 2024 (Medicare, Ambetter)

We are pleased to announce that, effective January 1, 2024, Express Scripts® will begin processing pharmacy claims for our plan members. See the details and FAQ.

6 Degrees Health – New Clean Claim Vendor Effective 1-2-24 (all products)

Buckeye Health Plan is pleased to share that we will be transitioning from Optum to 6 Degrees Health for our clean claim reviews. The Go-Live launch is tentatively set for January 2, 2024. See more details.

New Sandata Mobile Connect (SMC) Application for EVV Providers (Medicaid)

A new Sandata Mobile Connect (SMC) application was released in application (app) stores in July 2023. This is an enhanced app with a focus on the end user experience. In addition to an updated look and feel that simplifies navigation, the update includes a simplified login process and efficient reset password process. See more details.

Nursing Facility Claims Billing Value Code 31 (Medicaid, MyCare)

For Nursing facility claims, Value code 31 should only be used to indicate a Lump Sum amount, and not the individual’s monthly patient liability amount as indicated in OAC 5160-3-39.1. Buckeye Health Plan will separately apply any amount billed under value code 31 on nursing claims as a separate Lump sum payment. See more details.

New Chlamydia Screening Provider Toolkit (Medicaid)

According to the CDC, adolescent and young women have the highest rates of reported chlamydia infection. Approximately 20 percent of untreated chlamydia infections lead to PID and may cause pregnancy complications such as preterm labor and passing the infection to the infant during birth, leading to blindness and pneumonia. We’ve built a toolkit for you with materials you can use to discuss the screenings with adolescents, young women and parents of minors.


For Your Information

METS Program for Behavioral Health Update (Medicaid)

We previously shared with you our Members Empowered to Succeed (METS) Behavioral Health clinical program within Buckeye Health Plan. It has been successfully supporting Ohio providers and members for two years. METS takes a unique approach to member care focusing on the individualized needs to create a recovery roadmap. To aid in your understanding of the program, we’ve added how the process works.

‘What We Have Done For You Lately’ Website Page (all products)

See our Success Story, Dr. Thomas Lehner, Medical Director's feature and sound bite, as well as the latest updates on initiatives we are working on to make working with Buckeye easier.

The PCG Match Portal (Medicaid)

Ohio Department of Medicaid has created ‘The PCG Match Portal’ for use by members, independent providers, HH agency providers, and case managers. See if this would be of interest to you.


Professional Opportunities

Weitzman ECHO: Improving Women’s Health in Primary Care Starts December 14 (all products)
Improving Women’s Health in Primary Care is a no-cost continuing education learning community for primary care medical providers and behavioral health providers working in Ohio. This ECHO will feature a multidisciplinary team of experts in obstetrics, gynecology, menopause, women’s mental health, and more! Register here.

October 2023 Newsletter Content 

October 31, 2023



CEO Sarah London Named One of Fortune’s 2023 Most Powerful Women
Coming in at No. 40 on the list, Sarah joins 100 women leaders, including 67 women CEOs from organizations such as CVS, General Motors and UPS. Read more about the ranking criteria and other details.

BHP Expanding PA Program to Include Non-Emergent MSK
Effective January 1, 2024, Buckeye Health Plan is expanding our prior authorization program to include non-emergent MSK procedures. The expansion includes inpatient and outpatient hip, knee, shoulder, lumbar and cervical spine surgeries for Buckeye Health Plan members. See the full announcement for all the details.

Important: Medicare Policy Updates Effective January 1, 2024
See the latest updates to Medicare Policies effective January 1, 2024.

Is Your Provider Portal Locked Out?
Buckeye Health Plan has a commitment to maintain the highest level of security for our government partners, the provider portal enforces a 'One Year Password Policy.' This policy mandates that passwords be changed before 365 days. See steps to take to check on your account

Supporting Members with Substance Abuse Disorder 
Buckeye Health Plan, in collaboration with Wayspring, has launched a data-driven SUD Home Program that focuses exclusively on supplementing existing services, filling gaps in care, and meeting the complex physical, behavioral, and social needs of individuals with substance use disorder (SUD). Read more about the program and who to contact.



Appointment Access Measures Matter to Members
Under Buckeye Health Plan’s contract, providers are to maintain sufficient facilities and personnel to provide covered physician services and ensure that such services are available, as needed, up to 24 hours a day, 365 days a year. Each participating provider will offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid fee-for-service if the provider serves only Medicaid members. See why this is important

Prior Authorization – Emergent and Post-Stabilization
Reminder: Emergent and post-stabilization services do not require prior authorization. Urgent/emergent admissions require notification within one (1) business day following the admit date. See more details around understanding prior authorization requirements to lead to faster and smoother processing.

Claim Submissions Limited to 5,000
Ohio Department of Medicaid (ODM) is aware trading partners are submitting Electronic Data Interchange (EDI) transactions with more than 5,000 CLM segments. Submissions of over 5,000 CLM segments are causing downstream issues and affecting the delivery of corresponding 277CAs back to trading partners. See more details.


For Your Information

‘What We Have Done For You Lately’ Website Page Includes Initiative Updates (All products)
See our most recent updates on initiatives we are working on to make working with Buckeye easier.

Hamilton Medical Inc. Recalls HAMILTON-C1, T1, MR-1 Ventilators for Capacitator Leaks and Short Circuits
Hamilton Medical, Inc. is recalling the HAMILTON-C1, T1, MR-1 ventilators because the capacitators may leak electrolyte fluid onto the ventilator’s control board. If the control board contacts the electrolyte fluid, the control board or installed spare parts could short circuit. As a result of the short circuit, the ventilator may switch to “Ambient State.” See full details.

HPV Vaccine in Pre-teens/Teens is Essential
The data is in…and the American Academy of Pediatrics (AAP) recommends routine HPV vaccination for females and males. The AAP recommends starting the series between 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series. Read more details.

Help Your Patients Understand Their Health and Health Care 
We’ve created a guide intended to show you and your staff how to help patients understand their health and health care, so they can manage their health needs and feel comfortable discussing those needs with you. See how Buckeye can help you clearly communicate with your patients.


Professional Opportunities

Suicide Risk Modules are Available
Are you aware that our National Provider Webinar events that are available to any Centene provider, stakeholder, community member and/or staff. Webinars are on clinical topics appropriate for web learning and usually offer free continuing education hours. There are upcoming Suicide Risk courses that may be of interest to you.



Welcome to the September 2023 Provider Update Newsletter

September 29, 2023



Behavioral Health Modifier Requirement Update for Nurse Practitioners Effective 11-1-23 (Medicaid)
There are changes to the Modifier SA used when the Nurse Practitioner (NP) is assisting with any other procedure that does not include surgery in accordance with MTL No. 3336-18-01.  Please see the details.

‘Good Measures’ Diabetic Support Program (Medicaid & Ambetter)
We are pleased to announce a new Good Measures Diabetic Support Program that provides clinical coaching, nutrition guidance, and condition management support to Buckeye Health Plan Medicaid and Ambetter members, through our Diabetes Support Program. The program will launch for Medicare the end of 2023. The program is available at no cost to the member. Check out the website page for eligibility, program description and more.

RxEffect Bonus Program (Medicare)

Last month, we incorrectly identified this program for Ambetter providers. This program is for Medicare providers.

IMPORTANT: AVOID CLAIM DENIALS – Make Your PNM updates before October 20
Effective October 20, Next Generation Medicaid managed care organizations (MCO), the OhioRISE plan, and MyCare Ohio plans must use provider data from Ohio Medicaid’s Provider Network Management (PNM) module as it is the official system of record. See the details

ODJFS Rolls Out E-Signature Feature for Ohio Benefits Recipients (Medicaid)

The Ohio Department of Job and Family Services (ODJFS) Director Matt Damschroder announced on September 13, 2023, a new electronic signature process that will save Ohioans time when applying for certain benefits by phone. The new tool is now available statewide to make signing up for Ohio food stamps, Medicaid and cash services easier. See the ODJFS Release on our website.

ODM Revalidations (Medicaid)

All Ohio Department of Medicaid (ODM) providers are required to revalidate or renew your ODM provider agreement every three years or five years. Credentialed provider types are subject to three-year provider agreements and are both revalidated and recredentialed at that interval. See all the details.

2023 CPC Fall Learning Collaboration (Medicaid)

This year, Ohio Department of Medicaid (ODM) will be hosting a virtual CPC Fall Learning Collaborative in place of the Annual Summer Learning Session. See the website for more information.

New ‘Monthly Spotlight’ for Health Equity (All products)

Buckeye Health Plan believes in achieving health equity, eliminating disparities, and improving the health of our members from all groups. To support our providers in their efforts toward Health Equity, we started a new Monthly Spotlight feature to share information that may be helpful to our providers.


For Your Information

‘What We Have Done For You Lately’ Website Page Includes Initiative Updates (All products)

We’ve added updates to our initiatives we are working on to make working with Buckeye easier. We’ve also added a brief new video from one of our Care Guides and one of our Care Managers. See the latest updates.

Dexcom Continuous Glucose Monitoring (CGM) Training (Medicaid)

Dexcom is excited to announce an educational web series beginning September 7 through October 19, every other Thursday starting at 12:30 p.m. (approximately 30-45 minutes). See our website for more information.

Fight Against the Flu: Encourage Vaccination for All Your Patients (All Products)

Flu season is right around the corner, and it’s time for everyone to get up to date on vaccinations. With your patient’s trust and their best interest at heart, it’s up to you to recommend they get their flu vaccine.  See details on what you can do to help your patients.

Clinical Practice and Preventive Health Guidelines (Medicaid & Ambetter)

The latest version of the Clinical Practice and Preventive Health Guidelines has been posted to the website.”



Provider Satisfaction is Essential (All Products)

Buckeye Health Plan, via SPH (Press Gainey), will soon be canvasing a random sample of providers from across the state to measure your satisfaction with us and several areas within Buckeye. If selected, we ask that you take time to provide feedback. We truly value your input and use that information to enable us to deliver for you and your patients. Please be on the lookout for the survey.

Closing Gaps for Diabetic Eye Exams (All Products)

We want to remind you, PCP documentation in the medical record helps reflect gap closure for Diabetic Eye Exams. The information to include in the medical record must come from the vision provider (ophthalmologist or optometrist). Some easy options to help obtain:

  • Ask your patient to provide the vision provider to you so you can reach out.
  • Ask your patient to ask the vision provider to provide the information to you.

To close this gap, PCPs and Vision Providers must work together to get the documentation in the PCP patient medical record.

Quality Measures for Statin Therapies (Medicaid & Medicare)

CMS considers statin use in patients with cardiovascular disease and statin therapy in members with diabetes very important quality measures that should be appropriately managed and monitored. See the initiatives Buckeye has put in place to ensure quality care of the members we serve.


Feature Articles

Keep recording the “BMI” ……….it has great benefit!

We’ve put together a list of benefits to remind you why you should keep recording the BMI for adults and children.